Macrobiotic diet?

We have concerns that this diet can cause excessive weight loss in
some individuals and contribute to cachexia - loss of muscle mass, or
wasting.

"The macrobiotic diet is based loosely on Japanese eating
patterns and principles of Traditional Asian Medicine. The traditional
macrobiotic diet is vegan, consisting of whole grains, vegetables,
seaweeds, fermented foods, nuts, seeds, and seasonal fruits. It excludes
meat, eggs, and dairy products, and fluid intake is restricted, although
some more liberal forms of the macrobiotic diet include fish and other
animal products." [1]

Massage

Physical manipulation of the body to induce relaxation
and promote healing

Therapeutic massage appears to
have positive physical and emotional benefits that may offset the effects
of treatments for cancer

CAUTION: "for lymphoma patients undergoing
treatment, having a therapeutic massage can be especially helpful in
relieving pain, fatigue and anxiety. However, experts caution that there
are some inherent risks in getting a massage that patients should know
about before having one done.

"For lymphoma patients, the massage has to be performed by someone
who is familiar with working with cancer patients," says Kathleen
Wesa, MD, assistant attending physician in the Integrative Medicine
Service at Memorial Sloan-Kettering Cancer Center. "You can't go to
any massage therapist. There are some considerations, for example, if
someone's blood counts are low, if the patient has had surgery or lymphedema.
You don’t want to be doing deep tissue massage on someone who has low
platelets or on someone who is frail."
2

Mind
over Body - over cancer?

Can positive thinking
affect treatment and outcomes?

Does stress
cause cancer?

From: Preventing Cancer Is There a Link Between Stress and Cancer?
By GINA KOLATA

... But the results were clear: there was no association between stressful
events in the previous five years and a diagnosis of breast cancer. Other studies had the same result.
Still, not everyone was convinced.

Comment on the caveats
and limits of
positive thinking:

Our instinct is to swim
hard
against the direction of a current, but experienced
swimmers
know this is not the best way to escape a rip tide.

Certain kinds of
stress or chronic reactions to stressful events are strongly linked to some illnesses.
And it may be that stress is sometimes a contributing factor in the
origin of some cancers as described in the study below.

And there is no question that
chronic fear and sadness degrades our quality of life, putting our
health at risk.

So it seems evident that mindfulness, meditation, prayer, and exercise can improve how well we live and experience life, and
contributes in a positive way to our
general health.

The positive effects of such practices may also improve our ability to make
better-informed medical decisions - to consider in a more deliberate and
calm way the full range of
reasonable treatment options and seek the best expert
guidance.

What is highly implausible and
counterproductive, however, is the notion that we can alter the
course of
an existing cancer -- or influence if a treatment works with the power
of our mind.

It's widely accepted for good empirical reasons that there is no placebo
effect against cancer, a reason we don't have placebo controlled cancer
studies -- it would be unethical.

The unfounded belief that positive thinking can cause a cancer to
regress or make therapies work better can increase our stress and diminish
our quality of life as it causes us to worry about our anxiety --
increasing what we are attempting to limit by our act of will.

... It also leads to self-blame
- as in, " I failed my family: I did not believe hard enough to
overcome the disease."

... Another danger is that we can stay with an an unproven
alternative practice too long, convinced that it
will work if we just try harder.

Perhaps a way to avoid overreacting to stress
is to recognize and accept that fear and sadness is a natural reaction to
a very difficult
circumstance. A human reaction to an all-to-common affliction.

... "Touching bottom" is not the same
as accepting that all is lost or that this fight with this cancer
cannot be won ... but only to recognize that being human we are mortal
and have limitations - but also many opportunities to win battles -
and opportunity to live well on this day in this
moment.

The authors observed a slightly increased overall cancer risk in
bereaved mothers at 7-18 years of follow-up. There was an increased
risk for smoking-related malignancies among bereaved mothers during
the 7-18 years of follow-up. The authors observed no significantly
increased relative risk of breast carcinoma, alcohol-related
malignancies, virus/immune-related malignancies, or hormone-related
malignancies.

Melatonin

Questions and
related abstracts

Melatonin
is a natural hormone, normally created by the pineal gland. It is
stimulated by darkness and inhibited by light. It regulates the
human biological clock. Melatonin is a highly important
antioxidant, it may also modulate immune function.

Questions:

Should Melatonin be avoided by patients with immune
system cancers?

Can Melatonin reduce side effects of chemotherapy
without compromising efficacy?

Related Resources & Research News:

A randomized trial of CHOP
chemotherapy with or without melatonin in patients with favorable
prognosis large B-cell lymphoma. -ASCO
2004 ~ Abstract No: 8066

"The addition of melatonin to CHOP
chemotherapy did *not* decrease the incidence of neutropenia after
cycle 1 in this patient population. In addition, this study suggests
that there is no improvement in neutrophil nadir, CR rate, infection
rate, or change in hemoglobin or platelet counts with the addition of
melatonin."

Why
we are skeptical

Low Dose Naltrexone (LDN) is promoted as
a anti-cancer therapy by Dr. Bihari on a website named LDN and Cancer.2 A case report1 cites the reported outcomes for LDN
on this website as a
rationale for LDN and reports on the outcome. Here we list the many
reasons to be skeptical about the reports.

Regarding the LDN and Cancer website:

First, we call attention to many red flags in the text, which begin
with a qualifying statement about the need to do prospective studies
(giving the appearance of objectivity), but consistently maintains
that cancer patients benefit from the use of LDN - the estimate
being more than 60%.

From => "Although prospective, controlled clinical trials on LDN in the
treatment of cancer are yet to be accomplished, as of March 2004 clinical
"off-label" use of this medication by Dr. Bihari in some 450 patients with
cancer almost all of whom had failed to respond to standard treatments suggests that
more than 60% of patients with cancer *may significantly*
benefit from LDN." 2

To => "It will clearly require extensive study of LDN in prospective,
controlled clinical trials to determine which cancers respond best and which
other therapies are complementary to or synergistic with LDN."2

The phrase "which cancers respond best" implies that it's known that some
cancers respond to LDN, which requires faith in Bihari's
reporting of the responses, which are not defined, are kept internally,
and have not been published in a respected
journal. The fact is that we don't know if ANY cancers respond to
LDN.

RED FLAGS:

Misleading information:
Regarding the text: "Although prospective, controlled clinical trials on LDN in the
treatment of cancer are yet to be accomplished as of March 2004 ...

We are not aware of any clinical trial using
low dose Naltrexone for any Cancer as of 2008!

Conspiracy of silence?
It would be a major story if 60% of patients who did not respond to chemo really benefited from LDN.
That it has not been covered by the media or the research community
would require a cover-up or conspiracy of silence - which would
require the complicity of thousands of experts who also get cancers,
whose loved one's get cancer.

Too many conditions? The
website text reports that patients with many types of cancers have
benefited from LDN: From Lung .... Ovarian cancers, along with
a host of intractable medical conditions, including HIV.

Consider the number of cancers and conditions for which LDN is
promoted:

Conflict of interest: Dr.
Bihari, who consults patients on the use of LDN, has an obvious financial conflict of
interest. We should consider the potential for bias is high when the
claims come only from the provider - in this case the consultant.

Practicing outside domain: Dr.
Bihari is not an oncologist or even an internist; his degree is in
Psychiatry and Neurology.

Regarding the LDN case study 1 published on the Internet:

"Bihari
reported that he has used LDN with promising results for people with
various malignancies including but not limited to primary cancers of the
bladder, breast, liver, lung, lymph nodes, colon, and rectum Over
the years, he has administered LDN to more than 450 people with cancer,
most of whom initially failed standard conventional treatments. 1

According to Bihari, 86 of the 354 patients followed regularly
demonstrated at least a 75% reduction in overall tumor bulk, and an
additional 125 patients demonstrated disease stability."[9] 1

The case report cites statistics provided
by Dr. Bihari in LDN and Cancer2 website, which
is internally kept response data, with no way to substantiate it. The outcomes are not the result of randomized studies; nor are the claims
made for specific indications. The outcomes are not defined.
For example, we don't know what response means or how long the responses
lasted. There is no independent assessment or verification.

in the case report 1:
no definitions of "reduction in bulk";
no definition of time to response or response durations;
no description of methods and how outcomes were measured …

no scientific method. Nothing "regularly demonstrated."

Dr. Bihari hasn't published his findings
for peer review ... the reference [9] in the case report is to a website that
promotes LDN, not a medical journal.

Be
aware, that the professional-looking case report does not
provide verifiable or reliable measures of outcome in the follow up:

At the 6-month follow-up on May 2, 2006,
T.M. stated that his nodes had almost completely resolved, and on examination, neither the large cervical nodes
nor the large inguinal nodes were palpable.

... At the time of this report, and per telephone communication from the patient’s wife,
T.M. remains asymptomatic from his disease, now 1 year after his last CT/PET imaging.

... Follow-up by telephone, reported
by the patient's wife, is the very opposite of objective independently assessed
evidence.

Furthermore, as noted in the report, the condition could easily
"represent a period of spontaneous
remission", which
is very common for follicular lymphoma.

The case study (any case report) cannot tell us how many
people have tried LDN and had no regressions, or if the intervention caused
the observed response, or were coincidental.

The report
ends with a conclusion that
ethical scientists would never make on the basis of a case report:

We believe that by the mechanisms presented
herein, LDN demonstrates significant potential to increase disease-free as well as
overall survival in people with FL.

Clearly, nothing has been demonstrated
regarding the proposed mechanisms.

That the authors suggest that LDN can improve overall survival
is especially baffling, when even large randomized studies with very long
follow up often fail to demonstrate this for treatments of indolent
lymphomas.

Recommendation: Dr. Bihari should publish his findings in a respected
journal, or make a public statement
contradicting the promotions of others who quote him to promote the
off-label use of LDN. If the data is judged compelling by his peers, he
will be able to attract capital to do a controlled study to prove his
claims. It really is that simple. The information on the LDN
website for cancers 2 should be removed until clinical studies
are done that demonstrate benefit for specific cancers.

We remind the reader that it's very easy to make claims (we could all dash
them off in seconds), but it's vital that we prove them before
promoting interventions for disease. In fact, it’s the law.

... It’s vital because without an evidence-based system we
would have no idea which therapy has true value and would be subjected to
endless sales promotions from all points on the compass.

Quercetin

Questions and related abstracts

Natural sources: onions, apple skin, black
tea

Flavonoids,
such as quercetin, are plant pigments which color flowers, fruits and vegetables. Thousands
of flavonoids have been identified; notable ones include
proanthocyanidins, quercetin, citrus bioflavonoids, black and green tea
polyphenols.

Resveratrol

Questions and related abstracts

Natural sources:
dark red grapes

It is produced by Vitis vinifera and
labrusca grapes and is found in grape products including red and white
wines. The consumption of muscadines and muscadine products, especially
those made from pomace purees, could help incorporate a significant
quantity of resveratrol into the average diet.

ON STABILITY and CONCENTRATIONS: Resveratrol
was stable for up to 5 days at 4 degrees C in the dark but was not stable
at room temperature without protection from light. Resveratrol was
detected in grape, cranberry, and wine samples. Concentrations ranged from
1.56 to 1042 nmol/g in Concord grape products, and from 8.63 to 24.84
micromol/L in Italian red wine. The concentrations of resveratrol were similar
in cranberry and grape juice at 1.07 and 1.56 nmol/g, respectively. [7]

Resveratrol, (RES-VEAR-A-TROL)
a phytoalexin found in red
grapes, appears to have anti-inflammatory (inhibited cox-2-cyclooxygenase),
anti-promotion, and anti-progression activity.

Bioavailability? Although trans-resveratrol appears to be well-absorbed by humans when taken orally, its bioavailability is relatively low due to its rapid metabolism and elimination
... Information about the bioavailability of resveratrol in humans is important because much of the basic research on resveratrol has been conducted in cultured cells exposed to unmetabolized resveratrol at concentrations that are often 10-100 times greater than peak concentrations observed in human plasma after oral consumption. Although cells that line the digestive tract are exposed to unmetabolized resveratrol, research in humans suggests that other tissues are exposed primarily to resveratrol metabolites.
Little is known about the biological activity of resveratrol metabolites, and it is not known whether some tissues are capable of converting resveratrol metabolites back to resveratrol (7).

Related Resources & Research News:

"According to a GlaxoSmithKline
spokesperson, an internal analysis of the kidney failure cases has
concluded that they “most likely were due to the underlying disease
… However, the formulation of SRT501 was not well tolerated, and
side effects of nausea / vomiting / diarrhea may have indirectly led
to dehydration, which exacerbated the development of the acute
[kidney] failure.”

Piceatannol, a hydroxylated analog of the chemopreventive agent
resveratrol,
is a potent inducer of apoptosis in the lymphoma cell line BJAB and in primary, leukemic
lymphoblasts. Leukemia. 2001 Nov;15(11):1735-42. -
PubMed